Male infertility problems can occur when sperms are limited in number or function. In this paper, we describe the clinical evaluation of male infertility. A detailed history, physical examination, and basic semen analysis are required. In addition, ultrasound, karyotyping, and hormonal studies are needed to determine specific causes of infertility. In addition, the World Health Organization (WHO, 2009) has developed a manual to provide guidance in performing a comprehensive semen analysis. Among the possible reasons for male infertility, nonobstructive azoospermia is the least treatable, because few or no mature sperm may be produced. In many cases, men with nonobstructive azoospermia typically have small-volume testes and elevated FSH. Although treatment may not completely restore the quality of semen from men with subnormal fertility, in some cases a successful pregnancy can still be achieved through assisted reproductive technology. 1. Introduction About 1 in 7 couples have problems conceiving, with a similar incidence worldwide. Over 80% of couples who have regular sexual intercourse and do not use contraception will achieve a pregnancy within one year, and approximately 92% can achieve a pregnancy within 2 years . Infertility affects males and females equally, although many people believe that infertility is a female problem. In Japan, especially, couples oppose insemination or adoption as an alternative to having a child carrying both parents’ genes, which means that males are likely to seek infertility evaluations when a couple has difficulty conceiving. The clinical evaluation of male infertility includes a detailed history, physical examination, laboratory tests, ultrasound study, and karyotyping. The two main purposes of the evaluation are (1) to identify any modifiable factors that can improve the man’s fertility status and (2) to identify any serious underlying conditions, such as testis cancer, osteoporosis, and endocrine or genetic problems that present first as infertility . 2. History-Taking for the Male Infertility Workup The infertility history should include a detailed account of the patient’s reproductive and sexual history, developmental, family, medical, and surgical history. The information to be included in each portion of the history is detailed below. 2.1. Reproductive and Sexual History For the reproductive history, any prior conceptions for the male with present or past partners, details of any prior difficulty achieving conception, past evaluations and treatments for infertility, and previous use of contraception
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